Yesterday, I was remembering on Twitter the boxloads of risk assessments Steven had drawn up during his time in the Unit. Every activity, inside and outside the house was risk assessed. Every human contact he had was risk assessed. Every place he visited was risk assessed. And the upshot of 1000s of risk assessments was that he was permitted to do very little. Look hard enough and you can find a risk in everything.
The risks were assessed using a phenomenal system. One part of the assessment looked at “possibility” and was rated from “highly likely” to “unlikely” (Note there was no room for “not at all”). The second part looked at ” outcome” and was rated from “intolerable” to “mild”. The real outcome for Steven was that he was prevented from doing mostly everything even when the score was ” unlikely” and “mild”. I guess if you’re that terrified, then even unlikely means it could happen. In a month of Sundays.
Just a reminder before I go on that we’re talking human beings here.
One of Steven’s things since he was little is to smell my hair. He used to do it with other people but since early teenage he just does it with me. I’ve never really seen it as a sign of affection but it is a sign of human contact. I’ve never had a problem with it but it was an ” activity” that was risk assessed and rated “likely” and “serious”. So subsequently had to stop.
Learning disabled people aren’t allowed to develop and mature in the risk assessment world, so if you did something at 8 that was scored intolerable, you’re stuck with that for the rest of your life. When I was 13, I went through a short lived phase of lighting my own farts. Possibly an ” intolerable” score. But I haven’t done it for 40 years and have no intention of doing it again. I’ve matured. My rating could safely be adjusted. Steven kicked a dog when he was 9 but 16 years on dogs are still considered “vulnerable” to a repeat “serious, likely” attack.
The fabulous Rob Mitchell replied to my tweets suggesting that riskassessments are not about the risk but about worry and helping the worrier. I agree. Its about liability. Give someone a plastic plate instead of a China one in case they throw it. Make someone sit in the dining room with a 12″ portable TV instead of the communal lounge with its 42″ plasma in case of? I’ve no idea. Risk assess learning disabled people in the same way that you might risk assess a dangerous dog or a faulty aeroplane and you either put them down or take them out of action.
I was mulling all this over yesterday as I was in a meeting to discuss draft two of LBBill. Lots of hope and energy about people being able to chose where, with whom and how they live their life. I love how we’ve got rid of terms like residential home, ATU, supported living and just talk about a person’s home. But then I think about the risk/liability stuff and wonder if that is one of the reasons why those places are still so popular. In risk terms they rate lower than someone living in their own home. Sure, some people die in State settings. Some mouthy family members talk about how dreadful they are. But for the most part, people are silenced. Nobody hears or knows what goes on there, so the risk of public exposure and liability is curtailed. The people living there have been put down or taken out of action.
When you’re not seen as human, normal life rules don’t apply. The State wouldn’t be accountable if I lit one of my farts and blew up W H Smiths but it would if I was an autistic man and I exploded my own home. Life in an ATU doesn’t stop risk – it just creates new ones. It doesn’t even really contain things. But what it does very successfully is hide things. Invisible lives don’t matter. They don’t count. The LBBill is going to be so bloody annoying because it has a polar position to the current thinking. Bloody hell – its saying that a learning disabled person has a right to live a risky, messy life. The bounders.
Love, Belief and Balls 
As luck would have it I am running a session on risk assessment and management this afternoon. I will give folk a copy of this as a reminder that the biggest risk fo all for people with learning difficulties is being stopped from having a life – thanks
Brilliant. Can I come?
This another of the wrong way round issues. People should be allowed to take risks and care agencies should be looking at the higher risk issues – it’s not going to be the end of the world if someone learns that too many Mars Bars make you sick – it’s part of learning – but no Mars bars might mean they take on an obsessive fascination and they never learn to handle this. I accept that where people have obsessive behaviours then we need to accept the need to divert/replace etc to help them be able to do more than eat Mars bars. However this is about knowing the person and learning together and knowing what you might try/do to help move things on. The life and death risks are the ones to start being clear about but also understand that the aim would always be to help people manage as much as they can themselves and to help when they can’t. Taking risks is normally part of our dynamic development and learning – it’s the ones which will do us irreversible damage that matter and we need to know the person and maybe using lower risk areas test out how best they learn. Some people can be crippled by anxiety if we open up too many choices and need a slower pace. Even small things can be too difficult one time but fine later – like the woman who’d lived in long-stay hospital for 35 yrs who couldn’t cope in her first Xmas with the idea that they would choose which meal they fancied across the Xmas period and needed a menu written out – but on later years had learnt to be able to choose day to day, having shopped to her preferences for the week. The idea that you risk assess everything is not only over-protective, oppressive and anti-growth and development but a waste of everyone’s time. I doubt support staff would have been able to know all the risk assessments done. The idea is to find ways to manage the real risks in order to help someone have a life! – and to keep things under review as both supporter and the person learn. Not much chance that an ATU is actually helping people to learn how to live outside the unit – life is messy and everything is not controllable without being in prison and losing all your rights to control…. whoops! Did I suggest ATU’s were like prison? I for one hope we get the LBBill default position and what the rest of us have – a life!
If they are going to risk assess they will also have to risk assess the effect on someone’s health and wellbeing of being stuck at home – inactivity, overweight, heart disease etc
My boys point blank refused to wear cycle helmets so my choice was to stop them riding their bikes on safety grounds or let hem ride them without helmets and take that risk. Allowing them to continue to cycle reduced their risk of getting unfit and overweight and allowed them to visit friends.
It’s not risk vs no risk. It’s balancing an obvious, hopefully immediate risk against a long term likely one.
Sorry last sentence should read ‘ …hopefully unlikely risk against a long term likely one.’
[…] That Risky Ol’ LBBill. […]
This reminds me of an excellent cartoon I once saw in Private Eye. It had a man in a top hat standing in front of an incredibly dangerous-looking and flimsy rope bridge over a deep gorge. The caption was “Victorian Risk Assessment” and the man was saying something like “This looks excellent!”. Maybe CQC should insist that all risk assessment forms should have photos of people sky-diving and climbing mountains on every page (but possibly not lighting their own farts) to remind people to put things in context?
Reblogged this on Ensuring an Ordinary Life for All and commented:
Love it….as Mark says…’ The LBBill is going to be so bloody annoying because it has a polar position to the current thinking. Bloody hell – its saying that a learning disabled person has a right to live a risky, messy life. The bounders.!!’
Risk assessments stem from a culture of liability.. But where was the risk assessment that said it was fine to leave a vulnerable adult with known epilepsy alone in the bath???